Dr. John R Lee - Interview with Carolyn DeMarco, M.D.
JL: Uterine fibroids are one of the most common problems of peri-menopause and one of
the leading causes of hysterectomy. Can you tell us exactly what a fibroid is from a
medical point of view?
CDM: Fibroids are benign tumors of the uterus. They're made of smooth muscle and
fibrous tissue. They can be located either outside or inside the uterus. They range in size
from a pea to a melon, but they're usually between the size of an orange and a grapefruit.
They're hard, white gristly tissue with a whorl-like pattern. Their size varies depending
on where you are in your menstrual cycle. There's no doubt that estrogen excess is the
main cause of fibroids.
JL: What are the symptoms that woman with fibroids might have?
CDM: Fibroids don't always have symptoms. When they do, the most common are heavy bleeding, pelvic pressure, and urinary frequency (you have to urinate more often) when they press on the kidney, bladder or ureter. Fibroids can also be on a stalk which can twist. Fibroids can also cause infertility and miscarriage.
JL: How are they best treated?
CDM: If there are no symptoms a "wait and see" approach is best, because fibroids will
usually shrink at menopause. Many doctors will recommend a hysterectomy even if there
are no symptoms. Fibroids cause 1/3 of all hysterectomies. There are other surgical
alternatives, such as myomectomy (removing only the fibroid) or hysteroscopy which
only removes the fibroid through the cervix. Both procedures take considerable surgical
skill. It's much simpler to take out the uterus than to take out a fibroid.
JL: Simple for the doctor and complicated for the woman.
CDM: That's right. The surgical complication rate for the ordinary hysterectomy is very
high - 40 to 50 percent. It's a complicated major surgery and the recovery time is quite
long. I am fundamentally opposed to taking out the uterus unless there's a serious
Often a surgeon will take out the ovaries as well, and that causes instant menopause.
Even if your ovaries are left, you tend to go into menopause an average of two years
earlier and some women's ovaries don't recover and they rapidly go into menopause. It's
shocking the number of ovaries that are taken out for no good reason. The vast majority
of hysterectomies are done between the ages of 20 and 49. Half of the women over 40
who have a hysterectomy are convinced to have both ovaries removed at the same time,
although there's rarely a medical reason to do so.
Removal of the uterus can also change your experience of sex negatively because you can
no longer have a uterine orgasm. If the ovaries are removed or when they stop
functioning within 2-5 years of a hysterectomy, you lose 50% of your testosterone and
some women lose their sexual desire as a result.
Also, research is now showing that the uterus has other functions: it secrete hormones
and other active substances such as prostaglandins which may play a role in preventing
JL: That's fascinating. Getting back to fibroids could a woman with fibroids as small as
one or two inches have symptoms?
CDM: They can, depending upon where they're located. I've found that fibroids located
in the wall of the uterus can cause quite a bit of bleeding.
JL: Would you say that's one of the primary causes of heavy bleeding?
CDM: Yes it is, along with excess estrogen in general. Peri-menopause is a time when
many women have heavy bleeding, and it is debilitating. It makes you feel panic stricken,
so when the doctor says, "Oh, let's just yank it all out, that will solve all your problems,"
that is almost an irresistible offer. But as we've discussed, it doesn't solve your problems
One thing I've found about women with heavy bleeding is that there's almost always an
emotional factor where you have too much to do, or you have too much stress, and you're
One of the biggest problems with heavy bleeding is iron-deficiency anemia. I've known
women who suffered for months who had excessive, debilitating fatigue, chest pains and
shortness of breath from anemia caused by heavy bleeding. If you're anemic, you'll bleed
more so it'll be a vicious circle. Sometimes women will just drag themselves around
thinking their fatigue is caused from trying to do too much.
Anemia is very easy to treat. Women generally report that they feel like a whole new
person after a month of iron supplements. Any women with heavy bleeding should have
her hemoglobin, iron stores and thyroid checked. If your thyroid is malfunctioning it can
cause menstrual irregularities and heavy bleeding, especially if it's under-functioning. I
don't recommend that women just start taking iron supplements. If you have these
symptoms you need to find out what's going on.
JL: How do you treat heavy bleeding?
CDM: I have found that natural progesterone is often very helpful in bringing the system
back into balance. I also recommend high doses of bioflavonoids (over 1,000 mg per day,
especially quercetin and rutin) because that improves blood clotting and strengthen the
capillaries in the uterus.
JL: How do you treat fibroids in your patients?
CDM: I break into steps:
1) Decrease the estrogen overload (with progesterone and DIM)
2) Support liver function
3) Increase pelvic and general circulation. Vitex is good for this
4) Check for low thyroid and adrenal function
5) To reduce estrogen, it's important to maintain a healthy diet and support the liver. If
your liver isn't working well, estrogen can stay in your system longer than it's supposed
to. To stimulate the liver you can use lemon juice, and put bitter greens such as
dandelion greens, endive and radicchio in your salad. You can take liver-supporting
herbs like milk thistle, dandelion root and turmeric.
6) I also suggest taking a B-complex vitamin
7) The other way to reduce the estrogen imbalance of course is with natural progesterone
cream. It's a key component to treating a fibroid. I put every fibroid patient on a natural
progesterone cream, applying it days 12 to 26 of the cycle, ¼ to ½ tsp twice per day.